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HomeMy WebLinkAboutBuilding Permit #047-14 - 145 BRIDLE PATH 7/12/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 14 Date Received Date Issued:� IMPORTANT:Applicant must complete all items on this page 'LOCATIO : rIC� (�C a N Print; PROPERTY OWNER LQQTC 1 Q ' Print 100 Year Old Structure est no­ Print N�a PARCEL: ZONING DISTRICT: Historic•District yes no .. es no Machme.Shop Village y TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg VOthers: ❑ Demolition Other 115< Ln El Septic 0 Well ❑ Floodplain. ❑Wetlands El Watershed District El Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: R.kr sew Gnd -insu tate Der Massave �I Identification Please Type or Print Clearly) OWNER: Name: LQure n qC t Phone: Address: L J CONTRACTOR Name: � . �- x f � � - ` Phone:Q� _3� - 23' 'Address ca�M� �� Supervisor's Construction License CS Ot Exp Date. Home Improvement License:: tc ."Exp. Date. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ -31, LA L (6 . 5 1 FEE: Check No.: ��..,� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to e r fund j Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans Location � � r r �. No. o Date 1 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fey $ Other Permit Fee $ TOTAL $ Check# v C Building Inspector Location / �(Gl C( ��q q�. ' v No. ()()q Date TOWN OF NORTH ANDOVER l T d Certificate of Occupancy $ Building/Frame Permit Fee $L , f Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# , `—e Building Inspector I I Plans Submitted❑ Plans Waived❑ Certified Plot Plan ❑ Stamped Plans ❑ ._-TYPE OF.:SEWERAGEDISPOSAL -- - ❑ ' Public Sewer ❑ Tanning/Massage/Body Poolsody Art ❑ Well ❑ Tobacco.Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc..- ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED: DATE APPROVED PLANNING & DEVELOPMENT ❑ COMMENTS i -CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes-.- Planning es -Planning Board Decision: Comments Conservation Decision: Comments i Water & Sewer Connection'/Signature« Date Driveway Permit ]DPW Tovvi2 Engineer: Signature: Located 384 Osgood Street DEPART 'If.NT =Temp Dumpster on site- yes.. . no Located'at 124 Mair Street.: Fire Department signatureldate COMMENTS i t Dimension fee of floor area based on Exterior dimensions. f Stories: Totals square t Number o q , Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drops requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA— (For department use) i ® Notified for pickup Call Email - i Date Time Contact Name Doc.Building Pennit Revised 2014 � Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products issuance of Bldg Permit NOTE: All dumpster permits require sign off from Fire Department prior to g p p q 9 Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets.of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 NORTH q Town of t E �� Andover O y 0% No. - h , ver, Mass, 1 A- coc.yicyuw.cn 7d AR^TEO S lS IJ BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT . BUILDING INSPECTOR. .. .. .. . . has permission to erect .................. buildings on ...... . „ Foundation Rough ..1.r......To. ............................ .............. ..................... Chimneto be occupied as ............ ... ... .....® .. .... y provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final I lop PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU STA Rough 1 Service ............ .. ....... ........ .......................... Final BU TOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE i CONTRACT F - OR PRODUCTS / SERVICE W nationalgrod Conser atlon ORK HERE WITH YOU.HERE FOR YOU. Services Group This service is brought to you through support from your local utility This Agreement is made by and among and (� Conservation Services Group(CSG) Atte:RCS � Lauren Earle �� ` 50 Washington Street,Suite 3000 145 Bridle Path Westborough,MA 01531 North Andover,MA 01845-2009 Reg.No. 173484 Project ID:P00000132771 Contract ID:20130404 WORK Federal ID No.222457170 Site ID:S00002128525 (Mail completed contract to address above) I. DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the following work on these"Premises"in a professional manner and in accordance with the terms of this Contract,including the attached recommendations/work order describing the work in detail(the"Work")which are incorporated herein by reference: Description Quantity Location Insulation Removal 46 NIA 548,30 Attic Floor Open Blow Cellulose 7" 896 Living Space 51,254.40 Propavent 2'or 4' 48 Attic $168.00 Install 2"Thermal Barrier Polyiso On Kneewall 168 Living Space $675.36 Insulate Rim Joist with 6.25"Fiberglass Batting 46 living Space S96.14 � Damming 56 NIA $103.60 Sub Total: $2,345.80 Energy Efficiency incentive $1,723.12 Net Sales Tax After Incentive 50.00 Total $622.68 Printed:41412013 Page 1 of 2 II. PAYMENT r Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows:Payment#1:$ 2 ,� 5 h as a Deposit payable to CSG upon signing the Contract(not to exceed 143 of the total retail costs or actual costs of special orders,whichever is greater).Mail check&contract to CSG, Attn:RCS,50 Washington St.,Ste.3000,Westborough,MA 01581.Final Payment:$ i5- 1 Z as the final payment for the Work shall be due and payable to the Independent Installation Contractor("IIG")upon. tisfactory completion of the Work Customer understands that he/she will not be required to pay the Utility Incentive Share of the Contract price in the amount of$ Z.The Utility Incentive Share is dependent upon the package purchased and/or prior incentive utilization.Changes to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. III.DISPUTE RESOLUTION The IIC and Custoxper hereby mutually in advance that in the event that the HC has a dispute concerning this Contract,the IIC may submit such dispute to a private arbitration service which has Been approved by 1ig�ce of Consumer Affair and Business Regulation and Customer shall be r9qWed . to such arbitration as provided in XG.L c 142k r Gustomcr: ( Contractor._,. '/ You ma cancel this agrl ment if it has been signed by a party theretoy" plac her than an address of the seller, which mmay be his main office or a branch there of, provided you noti the seller inWriting at his main office or branch by ordihary mail posted, by telegram sent or by delivery,not later than midnight of the third business day following the signin of this a e nt. DO NOT SIGN THIS CONTRACT g / IF THER/E� ARE ANY1�BLANK SPACES. ' 1J �arlS 'ucT?'ry.� Cui: r "o a Datk Indicate your selected IIC ere,if applicable (OR) Initial here if you want l"t�r!L the Program to assign a SG!rp(ire Date Name of CSG Representative(Prvrted) Participating Contractor TERMS AND CONDITIONS APPEAR ON THE REVERSE. 1/13 y/,1 atm CONTRACT FOR 4 nationalgrid Cons PRODUCTS I SERVICE WORK er atlon HERE WITH YOU.HERE FOR YOU. Services Group _ _ Y This service is brought to you through support from your local utility This Agreement is made by and among and t Conservation Services Group(CSG) Lauren Eaglet Attn:RCS 50 Washington Street,Suite 3000 145 Bridle Path Westborough,MA 01,581 Notch Andover,MA 01845-2009 Reg.No. 173484 Project ID:P00000132771 Contract ID:20130404 ASEAL, Federal ID No.222457170 Site ID:S00002128525 (Mail completed contract to address above) I. DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the following work on these"Prenuses"in a professional manner and in accordance with the terms of this Contract,including the attached recommendations/work order describing the work in detail(the"Work")which are incorporated herein by reference: Description Quantity Location Attic Stair Cover Thermal Barrier with carpentry 1 Living Space $237.65 Whole House Fan Box:Thermal Barrier Potyiso 2"(Attic) 1 Living Space $154.32 Perform Air Sealing at Estimated 62.5 CFM50 Per Hour 8 Living Space 5616.00 Door Sweep 2 N/A 542.34 Exterior poor Weather Stripping 2 N/A S50.40 Sub Total: $1,100.71 Energy Efficiency Incentive $1,100.71 Net Sales Tax After Incentive $0.00 Total 50.00 i I Printed:4/4/2013 Page 2 of 2 11. PAYMENT Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows:Payment#1:$_ as a Deposit payable to CSG upon signing the Contract(not to exceed 1/3 of the total retail costs or actual costs of special orders,whichever is greater).Mail check&contract to CSG. Atter:RCS,50 Washington St.,Ste.3000,Westborough,MA 01581.Final Payment:$ 3C as the final payment for the Work shall be due and payable to the Independent Installation Contractor("IIC")upon satisfactory completion of the Work Customer understands that he/she will not be required to'pay the Utility Incentive Share of the Contract price in the amount of$ 1100. ) l .The Utility Incentive Share is dependent upon the package purchased and/or prior incentive utilization.Changes to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. Ill.DISPUTE RESOLUTION The IIC and Custome hereby mutually agree in advance that in the event that the IIC has a dispute concerning this Con the C may submit such dispute to a private arbitration service which approved by the of Consumer Affairs and Business Regulation and Customer shall be bmit to such arbitration as provided in M.G.L.c 142A. Customer Contractor. You ma cancel this agreefont if it has been signed by a party there to a place o her than an address of the seller, which y be his main o or a branch there of, provided you notify the seller in writing at his main office or branch by ordi ry mail posted,b telegram sent or by delivery,not later than midnight of the third business day following the sign" f this agre a DO NOT SIGN THS ONTRACT IF THERE ARE ANY BLANK SPACES. Ctuti r r e Date Indic/ate vori�r sclecteci IIC here,if applicable (OP) Initial here if you want �� the Program to assign a CSG S' ate- Name of CSG Representative(Printed) Participating Contractor D TERMS AND CONDMONS APPEAR ON THE REVERSE. 1/13 i �f 9, 121 a mass save ru C1 � �tl c 1; C11". PERMIT AUTHORIZATION FOR / I, Lauren Eagle ,owner of the property located at: (Owner's Name,printed) 145 Bridle Path North Andover (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. X O er's Signature 04/04/13 Date FOR CSG OFFICE USE ONLY I Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: I Participating Contractor Date I I i Rev.12132011 I A��® CERTIFICATE OF LIABILITY INSURANCE DATE //22013013 Y) 07/10505 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Michael Emond Emond&Associates PHONE - FAX 857 Turnpike Street E-MAIL AIC208-471-1 No ADDRESS: Sore 133 _ North INSURERS AFFORDING COVERAGE MAIC# h Andover MA 01845 INSURER A: Farm Family Casualty Insurance Com an INSURED HRH Construction INSURER B: 80 Campbell Road INSURER c: INSURER D: North Andover MA 01845 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: j THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS i CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AD—DL SUBRPOLICY EFF- POLICY EXP LTR TYPE OF INSURANCEINSR POLICY NUMBER MM/DD MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 4 X COMMERCIAL GENERAL LIABILITY I I a occurrer r PREMISES Ence $50-000 CLAIMS-MADE �OCCUR MED EXP(Any one person) $5,000 A 2001X0726 11/20/2012 11/20/2013 PERSONAL&ADV INJURY $ Included GENERAL AGGREGATE $2,000,000 GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2.000.000 X POLICY PRO-JECTLOC $ AUTOMOBILE LIABILITYI� COMBINED SINGLE LIMIT Ea..dent 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURYPer accident $ A AUTOS AUTOS 2001C4287-4A 03/16/2013 03/16/2014 ( ) X X NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ I X UMBRELLA LIAB X OCCUR —F EACH OCCURRENCE $ 1,000,000 •I A EXCESS LIAS CLAIMS-MADE 2001E1169 12/14/2012 12/14/2013 AGGREGATE $ 1,000,000 DED X RETENTION$ $ WORKERS COMPENSATION I WC STATLL OTH- AND EMPLOYERS'LIABILITY Y/N DRYLIMITS ANY PROPRIETOR/PARTNER/EXECUTIVE A OFFICE/MEMBER EXCLUDED? ❑ N/A 2005W6827 12/07/2012 12/07/2013 E.L.EACH ACCIDENT $500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $500 000 If yes,describe under F_ r F -RATIONS below OPr E.L.DISEASE-POLICY LIMIT $500,000 I I l i I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Operations by named insured I I I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE LICY P OVISIONS. AUTHORIZED REPRES i ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Clear All f The Conunottwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.tnass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Legibly Name(Business/Organization/Individual : . - ) Address:_ , r City/State/Zip: ML C V1 `Wh,-0) Phone.#: (I J& (a9-2_14_f_-'�� Are y an employer?Check the appropriate box: Type of project(required):. 1. I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).*. have hired the sttb-contractors 6. ❑New-construction 2.0 I am a''sole proprietor or pa.�ner- listed on the'attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. employees and have workers' [No workers'comp,insurance comp-insurance.$ 9 EJ Building addition required.] 5. Q Weare a corporation and its 10-El Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t e. 152,§1(4),and we have no employees.(No workers' 1.3.VOtherff)SU(C-.fi CP comp.insurance required.) 'Any applicant that checks bbx#1 must also in out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the-sub-contractors have employees,they must provi&their workers'comp.policy number. • I I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: >( t7lM I lP Policy#or Self-ins.Lie.#: ,2Q�P, �,c. f" 9a: j Z Expiration Date: Job Site Address:J Put h City/State/Zip: N. Attadi•a copy of the workers' compensation policy declaration page'(showing the polity number acid expiration date): II Failure_to secure coverage as required under Section 25A of MGL c_ 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine • of up to$250.40 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certrjy under t1, in a alties o P f perjury that the information provided above is true and correct Si ature: Date: 112 I Phone k --------------- L Official use only. Do not write in this area,to be completed by city or town official I City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityrrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person• Phone#• I ' i I Massachusetts_Department O; Board of Buil uai:; Safe-•• ding Regulations and SLancsards Cun,tructiun Suprni+ur License:C 4S-n54 WJLLjLAA#4nE1.'ft NMDOyW MA 01845 = Commissioner .:c 0..,:—� 03/04/2014 _ I ��anco�rmeal� /f/tatt OfTce of Consumer Affairs& o�'C� a064ma ME iMPRpVEME�CO Baseness Regulation License or registration valid for individul use only e9-�stration- CONTRACTOR before the expiration date. If found return to: :101730 Type: Of6ee of Consumer Affairs and Business R Prr�ton: s.6/2912Qj4 Private Cotporatict, 10 Park Plaza_Suite 5170 dation HRH CO NSTRUCTION•lNC:- Boston,KA 021I6 An'Fam Hope _ 1 80 CAMPBELL RD s, i NORTH ANDOVER,MA01845 Undersecretaary�- Not valid without si afore i